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No published information is available about myocardial infarction management in Spanish emergency departments. The EVICURE is a prospective, multicenter, observational study involving 35 hospitals that for a 3-week period collected all the cases of patients requiring care in which the final diagnosis of the cause of symptoms was ischemic heart disease. The study included 2,216 patients, of which 600 (27.1%) with acute myocardial infarction formed the study population. Fifteen patients died in the emergency department (2.5%) and 80 (13.3%) diagnosed as myocardial infarction were admitted to the ward instead of the coronary care unit. The median time before patients were admitted to the coronary care unit was 32 minutes versus a median time of 111 minutes for all patients. Before leaving the emergency room, 461 patients (76.5%) received aspirin and 93 (15.5%) underwent fibrinolysis. We concluded that there is room for improvement in light of current standards of care.

In the recent years, new possibilities have emerged in the diagnosis and management of acute myocardial infarction with ST segment elevation and its complications. Moreover, a deep transformation has taken place in the health care system organization, particularly in aspects related to care of patients presenting non-traumatic chest pain, both in pre-hospital and hospital areas. All these issues warrant a consensus document in Spain dealing with the role that these important changes should play in the whole management of myocardial infarction patients. This document revises and updates all the main clinical issues of acute myocardial infarction patients from the moment they contact with the health care system outside the hospital until they return home, after staying at the coronary care unit and the general hospitalization ward. All those aspects are considered not only in the uncomplicated myocardial infarction but also in the complicated one. This review also includes a set of recommendations on structural and organisational aspects, mainly referred to the prehospital and emergency levels.